Public health practitioners and researchers often refer to state public health systems as being centralized, decentralized, shared, or mixed. These categories refer to governance of the local public health units within the state and whether they operate under the authority of the state government, local government, shared state and local governance, or a mix of governance structures within the state.

This article describes the development of an objective method of classifying states as centralized, decentralized, shared, or mixed. These researchers also discuss some initial analyses that have been conducted to identify how public health resources and activities vary across states with different classifications.